Have you ever worked in a facility, came in one day and found that someone you had been working with was discharged and you have no idea what happened to them? I remember that happening a lot when I was a new grad, a few decades ago, in an acute-care hospital. The physical therapists were not really involved in discharge planning back then. Since that time, we are now active participants in discharge teams and we follow through with our patients to ensure they get to the appropriate next step when we have done all we can for them in our setting. That is care management. When I worked at the Visiting Nurse Service of New York CHOICE program, we were even eligible to become certified care managers. If I was discharging patients, I knew exactly where they were going next, when they should start there and who would be taking over their care at that point.
That doesn't seem to be happening here. I'm finding more and more clients who have been discharged from a service into oblivion. I saw a man yesterday who had a CVA years ago, but never had rehab after leaving the acute-care hospital. Trust me, he needed it. I saw a lady today who had a CVA in November of last year and I'm the first therapist she has seen since. The fascinating thing to me is that in both cases there are involved family who could have spoken up on the patient's behalf, but didn't due to lack of awareness of programs or options available.
There are lots of services available here, so that is not the problem. The only real obstacle I see is not a system one, but rather an attitude one. "That's not our remit," translates into, "That's not my job," and seems to be the pervasive attitude among many therapists here. Too often this week I've been thanked for "taking such an exceptional interest in me!" Is this the result of clinicians being the equivalent of civil servants? Is this simply the British mindset? I don't know but I sure hope I don't ever fall into the "not my remit" state of mind!